6. Policy Implications
Although relatively few children are exposed to four or more risks in their environment, for those that are exposed to this level of risk, one in two develop serious difficulties. These data also make it clear that boys are more at risk than girls, particularly for externalizing disorders. Boys are also less likely to experience positive relationships with their teachers, friends and siblings, factors that reduce the likelihood that they will develop disorder in high risk circumstances. Thus boys experiencing multiple risks in their lives who do not have satisfactory relationships that might act as a buffer are especially at risk. Consequently it is worth considering the role of targetted interventions for this relatively small group of children for whom the likelihood of problematic development is particularly high.
Early intervention and prevention is strongly indicated for children and families who are likely to fall into this high risk group. There is cross sectional evidence from other studies that risks potentiate one another. When someone becomes unemployed, their risk for depression increases (Bolton and Oatley, 1987). Depressed people are more likely to experience marital conflict (Coyne, Burchill and Stiles, 1991). Marital conflict is associated with increased problems in the parent-child relationship (Jenkins and Smith, 1991). The potentiation of risk must be investigated longitudinally, but if the longitudinal data confirm cross sectional data, risks may lead from one to another increasing the vulnerability of children. Intervention providing support to families before risks have multiplied will reduce the morbidity in children. Another argument for early intervention with families is that externalizing disorders show a high level of continuity over time. Children with externalizing disorders are not very likely to recover spontaneously, suggesting the need for early intervention before externalizing problems become entrenched (Patterson, Capaldi and Banks, 1991).
The data presented in this series of analyses makes it clear that relationships are central to children's well-being. Problematic relationships are associated with increased difficulties for children. Good relationships with siblings, friends, teachers and classmates at school can all help children develop modes of behaviour that are less problematic for them and those in their environment. These findings strongly suggest the need for a focus on relationships in any intervention. A number of early prevention studies with high risk mothers have been carried out (see Ramey and Landesman Ramey, 1998 for review). Results from these suggest that working with mothers to help them interact with their children in an affectively positive way can promote longterm positive outcomes. It is also clear, however, that programs targeted to helping children develop positive relationships with other people apart from parents may also be very beneficial. In classroom settings encouraging interventions in which children learn how to negotiate difficult issues in relationships and provide one another with support may be very beneficial. Many school intervention programs are geared to teaching instrumental skills such as conflict resolution in the management of relationships. There may be another element of relationships that is even more important for children: a sense of cooperation, interdependence and trust. At the core of the ability to build successful relationships may be the desire for interdependence and cooperation (Jenkins and Greenbaum, 1998). Creating circumstances of interdependence in which children rely on others to have their own goals met may foster a desire for cooperation and a sense of trust that has been previously lacking in their lives. Helping teachers build positive relationships with their most difficult children could also be encouraged. Teachers are most stressed by those children with externalizing disorders who take up much of their time and resources. They can feel guilty about devoting disproportionate amounts of time to these children to the detriment of better functioning children in their classrooms. Supporting classroom teaching so that teachers have time to build positive relationships with those children who are emotionally challenging and difficult may provide children with an experience that is ultimately beneficial. The beneficial impact of sibling relationships found for children at high risk, suggests the importance of building on these relationships as a preventative strategy. In therapeutic interventions with children and their families the focus is often on the parental marriage and the parent-child relationship (Nichols and Schwartz, 1995). It may be beneficial for therapists to focus more attention on the development of positive interactions in the sibling relationship as a means of providing children with relationships that may buffer future stress.
Although programs in early prevention at the family and the school level are likely to be exceptionally important in lessening psychopathology in children, the macrocontext within which families live should not be ignored. Societies in which the differential between the wealthy and the poor is greater show poorer scholastic, health and behavioural outcomes (Keating and Hertzman, in press). We can support our families that live in poverty through financial supplements, subsidized daycare, and educational opportunity. Successful early prevention programs have not just concentrated on helping families with parenting. They have also helped mothers deal with their problems by obtaining financial support, planning for their own return to education, reducing sources of marital conflict, etc. As a society we can put in place those structural supports that make family life easier, an intervention that would reduce the likelihood that children would be exposed to high levels of risk in their lives.
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